by Zach Read - email@example.com
Guam was a new experience for Bruce Cairns, who grew up in Chapel Hill, completed his undergraduate degree at Johns Hopkins, medical degree at the University of Pennsylvania, and surgery residency and trauma and critical care fellowships at UNC Medical Center. But it was a welcomed one.
As a Lt. Commander in the Navy, Cairns served as a general surgeon on active duty at the U.S. Naval Hospital on Guam, where he was introduced to Chamorro culture and gained greater appreciation for the history of the island, which featured prominently in conflicts ranging from the Spanish-American War to World War II to the Vietnam War.
For Cairns, who serves as John Stackhouse Distinguished Professor of Surgery at the UNC School of Medicine, Director of North Carolina Jaycee Burn Center at UNC Medical Center, and Chair of the Faculty at the University of North Carolina at Chapel Hill, Guam also helped him become a better physician and team member.
In Guam, he performed complex medical procedures, including vascular surgeries, that were not in his primary general surgical practice – and some that were entirely outside his practice such as craniotomies. He worked through natural disasters, including Super Typhoon Paka’s 230 mile-per-hour winds that left the island without power for two and a half weeks. Perhaps most career-changing, he treated victims of Korean Air Flight 801, a 747 airplane with 254 people on board that crashed on Guam in 1997 due to pilot error, hitting a fuel pipeline and bursting into flames.
Within two hours, 20 beds in the 25-bed Naval Hospital were filled with passengers in need of immediate care.
“Six months earlier we had done a disaster drill on the island and talked about our greatest fear,” says Cairns, who was the only team member with burn-treatment experience. “The greatest fear was an airplane crash with a significant number of burn patients because we had no capacity to take care of them. Six months later our fear was realized when the plane crashed.”
In that moment, but also more generally as a physician in Guam, Cairns learned to react quickly under challenging circumstances and to rely on everyone on the team.
“I learned an awful lot about myself as a surgeon, as a physician, and as a colleague,” he explains. “But I also had a chance to learn more about being a buddy and working together – in particular working with physician assistants and surgical technicians. We had people assisting in the operating room that had only six weeks of training. I was used to working with residents who had been training for years. In Guam, with all these different people working together without the experiences and resources you’d find at home, I gained an enormous appreciation for the military.”
The Buddy System
While finishing college at Johns Hopkins, Cairns began to reflect on his education and the ways he might give back in the future. He’d always been interested in the military. As he considered applying to medical school, it became clear that serving his country was the right fit.
“I graduated from college with a sense of obligation and of paying back what I’d been given,” he says. “I recognized that I benefitted from the way our country works, and I believe in what the military stands for, which was important in my decision-making because you have to be prepared to sacrifice for the greater good. We never know what may happen, whether it’s a 9/11 that changes the political landscape or some other catastrophic event. Soldiers and their families have to be prepared to make enormous sacrifices. In my case, even though I wasn’t being deployed in combat, my family and I had to be prepared for that sacrifice.”
Cairns completed his commitment to the Navy in 2005, after 19 years as a commissioned officer, but his desire to help the military only grew from that moment forward. In 2008, he made a trip to the Joint Special Operations Medical Training Center (JSOMTC) at Fort Bragg with a group that included Preston “Chip” Rich, MD, chief of trauma surgery at UNC, Charles Cairns, MD, his brother and former chair of emergency medicine at UNC, Tom Fischer, PhD, and Stan Eskridge, a UNC graduate and career entrepreneur.
The JSOMTC trains Special Forces medics from all branches of the military, as well as from militaries from across the Western world.
He’s taken it upon himself to look out for us and take care of us. It’s an extraordinary thing to do given how many other appointments and responsibilities he has. --Sgt. Eric Strand, Green Beret Medic (Ret.), second-year medical student at UNC
“We discovered there’s no better medic on the planet than the 18-Delta Special Forces Medical Sergeant,” he says. “It’s more difficult to become a Special Forces medic than it is to become an NFL football player – it truly is amazing. We are talking about the very best of the best.”
The first course at JSOMTC is the Combat Medic Course, which is taken over six months and is generally considered traditional military medic education. The second, much more selective and demanding course, is the Medical Sergeant Course, which requires an additional six months of training and includes elements of nursing, dentistry, surgery, veterinary medicine, public health, and health-care-related areas.
“You have to remember that these people are soldiers first, and under fire they have to be able to do a number of things quickly and decisively or the mission will fail,” says Cairns. “So, unlike medical school, these folks must train to achieve competence as opposed to be evaluated for performance or to get a grade. These soldiers must graduate from this program knowing how to do a tracheostomy, put in a central line, or stabilize a femur in a combat situation. It’s a different approach.”
As the group from UNC learned more about the level of training and the expertise of the Special Forces medics, they saw an opportunity to help JSOMTC instructors and medic trainees with education and career development. In collaboration with the JSOMTC, the School of Medicine, and UNC Medical Center, the Burn Center launched the Advanced Medic Instructor Training (AMIT) program.
AMIT provides Special Forces medic training instructors who have practiced skills in combat an opportunity to rotate at UNC Hospitals in any specialty they want, whether in the burn unit, the surgical intensive care unit, psychiatry, the emergency department, vascular surgery, or elsewhere. After they spend a month at UNC Medical Center, the medics give a Grand Rounds presentation, return to the Training Center at Ft. Bragg, and incorporate the lessons they’ve learned into instruction.
A number of instructors that have rotated at UNC Hospitals have gone on to medical school, osteopathic school, or school to become physician assistants or certified registered nurse anesthetists. Among them is second-year UNC medical student Eric Strand, a former Green Beret medic who credits AMIT with helping his transition to medical school.
“AMIT introduced me to the networking and professionalization skills that are critical to becoming a doctor,” says Strand, who was the military lead for AMIT for four years before enrolling at the UNC School of Medicine. “Through AMIT, I learned what medical schools are looking for, and the program helped ease my transition to school by giving me an early glimpse of the medical and educational environments at an academic medical center.”
For Cairns, the program matches the public service mission of the university, the School of Medicine, and UNC Hospitals.
“We’ve created an educational environment and a career-development platform for them,” Cairns says. “These kinds of programs have to be part of who we are as a university and a state. We all can play a part and contribute – we all can create the kind of buddy system that you find in the military.”
The Silent Professionals
Cairns’ active duty experience gives him an understanding of the obligations of active duty service members. At the Burn Center, he’s been able to communicate well with military families who may have a loved one receiving care.
“I can tell you it’s been a big help having people rotating up from Fort Bragg through AMIT,” he says. “I’ve learned a lot by watching them interact with active duty military members and their families.”
AMIT is a phenomenal opportunity for medics to come up and get real clinical experience in the Burn Center. Bruce’s unrelenting desire to help Special Forces medics has without a doubt been the driving force that has kept these important programs going. --Nicholas True, MD, Emergency Medicine resident at UNC, former instructor at JSMOTC
Through Joining Forces, the initiative started by First Lady Michelle Obama and Dr. Jill Biden that works with institutions to ensure that service members, veterans, and their families have the skills to find career opportunities when their service is complete, academic medical centers like UNC are striving to improve military cultural competency through programs like AMIT.
AMIT has also served as a model for another program that will improve cultural competency at UNC: the Physician Assistant (PA) program, housed in the department of Allied Health Sciences in the School of Medicine, which is set to launch in January 2016.
Cairns, as Joining Forces representative for the Association of American Medical Colleges, serves on the Steering Committee of the PA program.
“We have huge ambitions for this program,” he says. “It’s incredibly unique because of the military partnerships involved.”The PA program will be open to service members and civilians alike and will provide career development and support for service members transitioning to civilian life. It will also put individuals into the workforce and help address the critical provider shortage in North Carolina.
“A million North Carolinians are medically underserved,” says Cairns. “A lot of those who attend the program will be from rural environments and will want to take their skills home and be leaders, as they have throughout their careers.”
Through the PA program, and with Fort Bragg, the center of the Special Forces world, little more than an hour away, Cairns believes that cultural competency in relating to service members and military families at UNC Hospitals and the School of Medicine will continue to improve. UNC Health Care’s relationship to the military has already been recognized at a national level through the 2014 Freedom Award from the Department of Defense, which is the Department’s highest recognition given to employers for exceptional support of Guard and Reserve employees.
“The Freedom Award increases visibility of what we, as an organization, do for our military,” says Cairns. “But it also increases our obligation to fulfill our duty to the military. The award means to me, ‘Make sure you deliver now that you’ve received recognition.’ AMIT and the PA program are important ways we have delivered and will deliver in the future.”
Just as his military experiences in Guam helped shape him as a person and a physician, Cairns envisions service members adding to the perspectives of members of the UNC Medical Center and UNC School of Medicine communities.
“It’s important that we all contribute,” he says. “The military and the Special Forces will never ask for our help. They call themselves the silent professionals. But I can assure you they need and deserve our help.”
UNC Health Care one of 15 recipients of the 2014 Secretary of Defense Employer Support Freedom Award
The Freedom Award is the Department of Defense’s highest recognition given to employers for exceptional support of Guard and Reserve employees. This year’s recipients were selected from 2,864 nominations received from Guardsmen and Reservists for going far beyond what the federal law requires to support their military employees. Read more about the Freedom Award. UNC Health Care has a tradition of physicians, staff, and students who have served or are currently serving in the military. Read about trauma surgeon Amy Rezak Alger, chief of abdominal transplant surgery David Gerber, neonatologist Martin McCaffrey, Surgical Intensive Care Unit director Sean Montgomery, medical student and former Green Beret medic Eric Strand, and pediatric surgeon Timothy Weiner.